Turkish Neurosurgery 2019 , Vol 29 , Num 4
The Ivy Sign on Fluid Attenuated Inversion Recovery Images Related to Single-Photon Emission Computed Tomography Cerebral Blood Flow in Moyamoya Disease: A Case Report
Fumihiro MATANO1,Yasuo MURAI2,Asami KUBOTA1,Takayuki MIZUNARI1,Shiro KOBAYASHI1,Akio MORITA2
1Chiba Hokusou Hospital, Department of Neurosurgery, Chiba, Japan
2Nippon Medical School, Department of Neurological Surgery, Tokyo, Japan
DOI : 10.5137/1019-5149.JTN.19271-16.1 Moyamoya disease is an idiopathic progressive cerebrovascular steno-occlusive disorder characterized by the formation of numerous collaterals called Moyamoya vessels. Accurate evaluation of vascular status and cerebral blood flow (CBF) is needed for prompt treatment to prevent ischemic and/or hemorrhagic events. The pathogenesis of the ivy sign on fluid attenuated inversion recovery (FLAIR) images of Moyamoya disease patients is unclear. We report a Moyamoya disease case wherein the ivy sign changed in relation to single-photon emission computed tomography (SPECT)-measured CBF during progression and following treatment. A 49-year-old female presented with slight aphasia and right hemiparesis. Magnetic resonance imaging (MRI) diffusionweighted image revealed cerebral infarction in the left frontal lobe. Cerebral angiography images showed bilateral distal internal carotid artery stenosis and Moyamoya vessels. FLAIR images exhibited the ivy sign. We performed superficial temporal artery– middle cerebral artery (STA-MCA) bypass surgery with encephalogaleosynangiosis (EGS) and encephalomyosynangiosis (EMS) on the left side 6 months after first presentation. After operation, left-side resting CBF gradually improved on SPECT and the ivy sign decreased. On the other hand, right-side CBF gradually deteriorated at rest, and the ivy sign increased. Therefore, we performed STA−MCA bypass with EGS and EMS on the right side 4 years after first presentation. After the operation, the resting CBF increased and the ivy sign decreased. The FLAIR ivy sign may be a useful indicator of both deterioration and improvement of CBF status without the need for CBF imaging using contrast material. Keywords : Moyamoya disease, FLAIR, Ivy sign, SPECT
Corresponding author : Fumihiro MATANO, s00-078@nms.ac.jp